Perineal Lumps: Possible Causes and Treatment Options

Genital issues

My mother is 55 years old and had a stroke.
Three days ago, we discovered a lump the size of a marble on her buttocks that is hard and has been bleeding.
She says it doesn't hurt when using the bathroom, only when I touch the lump does it cause pain.
There is no foul odor.
Initially, we thought it was hemorrhoids, and an online consultation prescribed Amoxicillin, magnesium oxide, and a tube of Xylmol ointment.
However, upon closer inspection, it is not located at the anal area but rather in the perineal region.
Given this situation, what could this possibly be? Is it safe to start the antibiotics? Due to the pandemic, my father does not allow her to see a doctor, so we are seeking help here.
Thank you, doctor.

Miss Peng, 50~59 year old female. Ask Date: 2022/05/08

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, a visual examination or biopsy is necessary for confirmation.
I recommend that you apply for a telemedicine or in-person consultation as per the regulations to avoid any diagnostic errors.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2022/05/08

More Info

When it comes to perineal lumps, especially in a 55-year-old woman with a history of stroke, there are several potential causes and treatment options to consider. Given the description of the lump being the size of a marble, hard, and causing pain only upon touch, while also being located in the perineal area rather than directly at the anus, it is essential to evaluate the situation carefully.

Possible Causes
1. Abscess: One of the most common causes of a lump in the perineal area is an abscess, which is a collection of pus that can occur due to infection. If the lump is hard and painful, it could indicate an underlying infection that may require drainage.

2. Cysts: Sebaceous cysts or epidermoid cysts can develop in the perineal area. These are typically benign and can become inflamed or infected, leading to pain and discomfort.

3. Hemorrhoids: While you initially thought it might be hemorrhoids, they typically present with pain during bowel movements and may cause bleeding. However, external hemorrhoids can sometimes feel like lumps.

4. Skin Lesions: Other skin-related issues, such as warts or skin tags, could also present as lumps in this area. These are usually benign but can be bothersome.

5. Malignant Tumors: While less common, it is essential to consider the possibility of a malignant tumor, especially if the lump persists or changes in size or characteristics.

Treatment Options
1. Antibiotics: Since your mother has been prescribed Amoxicillin, it is a reasonable first step, especially if there is a suspicion of infection. Antibiotics can help reduce inflammation and treat any underlying bacterial infection.

2. Topical Treatments: The Xylmol ointment prescribed may help soothe the area, but it is essential to ensure that it is appropriate for the specific condition. If there is an abscess, topical treatments alone may not suffice.

3. Pain Management: If the lump is causing discomfort, over-the-counter pain relief medications, such as acetaminophen or ibuprofen, can be used to manage pain.

4. Observation: If the lump does not worsen and your mother is not experiencing significant pain or other symptoms, it may be reasonable to monitor the situation for a short period.

5. Surgical Intervention: If the lump persists, increases in size, or becomes more painful, surgical evaluation may be necessary. This could involve drainage of an abscess or removal of a cyst or other lesion.

When to Seek Medical Attention
Given the current pandemic situation, it is understandable that your father may be hesitant to seek medical care. However, it is crucial to prioritize your mother's health. If the lump shows signs of worsening, such as increased pain, fever, or spreading redness, it is essential to seek medical attention promptly.

Conclusion
While it is possible to start with antibiotics and monitor the situation, it is vital to remain vigilant for any changes. If the lump does not improve or if there are any concerning symptoms, it is crucial to seek medical evaluation, even if it requires finding a safe way to visit a healthcare provider. Your mother's health and well-being should always come first, and healthcare professionals can provide the necessary guidance and treatment options.

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